Subtitles and Transcript

Roger Stein

0:11
So this is a picture of my dad and meat the beach in Far Rockaway,or actually Rockaway Park.I'm the one with the blond hair.My dad's the guy with the cigarette.It was the '60s. A lot of people smoked back then.In the summer of 2009,my dad was diagnosed with lung cancer.Cancer is one of those things
that actually touches everybody.If you're a man in the United States of the America,you've got about a one in two chanceof being diagnosed with cancer during your lifetime.If you're a woman, you've got
about a one in three chanceof being diagnosed with cancer.Everybody knows somebodywho's been diagnosed with cancer.

0:54
Now, my dad's doing better today,and part of the reason for that is thathe was able to participate in the trialof an experimental new drugthat happened to be specially formulatedand very good for his particular kind of cancer.There are over 200 kinds of cancer.And what I want to talk about today ishow we can help more people like my dad,because we have to change the way
we think about raising moneyto fund cancer research.

1:20
So a while after my dad was diagnosed,I was having coffee with my friend Andrew Lo.He's the head of the Laboratory
for Financial Engineering at MIT,where I also have a position,and we were talking about cancer.And Andrew had been doing
his own bits of research,and one of the things that he had been toldand that he'd learned from studying the literaturewas that there's actually a big bottleneck.It's very difficult to develop new drugs,and the reason it's difficult to develop new drugsis because in the early stages of drug development,the drugs are very risky,and they're very expensive.So Andrew asked me if I'd want tomaybe work with him a bit,work on some of the math and the analyticsand see if we could figure out
something we could do.

2:00
Now I'm not a scientist.You know, I don't know how to build a drug.And none of my coauthors, Andrew Loor Jose Maria Fernandez or David Fagnan --none of those guys -- are scientists either.We don't know the first thing about
how to make a cancer drug.But we know a little bit about risk mitigationand a little bit about financial engineering,and so we started thinking, what could we do?What I'm going to tell you about is some workwe've been doing over the last couple yearsthat we think could fundamentally change the wayresearch for cancer and lots
of other things gets done.We want to let the research drive the funding,not the other way around.

2:37
So in order to get started, let me tell youhow you get a drug financed.Imagine that you're in your lab --you're a scientist, you're not like me --you're a scientist, and you've developeda new compound that you think might betherapeutic for somebody with cancer.Well, what you do is, you test in animals,you test in test tubes,but there's this notion of going from the benchto the bedside,and in order to get from the bench, the lab,to the bedside, to the patients,you've got to get the drug tested.And the way the drug gets tested is through a seriesof, basically, experiments,through these large, they're called trials,that they do to determine whether the drug is safeand whether it works and all these things.So the FDA has a very specific protocol.In the first phase of this testing,which is called testing for toxicity,it's called Phase I.In the first phase, you give
the drug to healthy peopleand you see if it actually makes them sick.In other words, are the side effects just so severethat no matter how much good it does,it's not going to be worth it?Does it cause heart attacks, kill people,liver failure, this kind of thing?And it turns out, that's a pretty high hurdle.About a third of all drugs drop out at that point.In the next phase, you test
to see if the drug's effective,and what you do there is you
give it to people with cancerand you see if it actually makes them better.And that's also a higher hurdle. People drop out.And in the third phase, you actually
test it on a very large sample,and what you're trying to determine
is what the right dose is, and also,is it better than what's available today?If not, then why build it?When you're done with all that,what you have is a very small percentage of drugsthat start the process actually
come out the other side.So those blue bottles, those blue bottles save lives,and they're also worth billions,sometimes billions a year.So now here's a question:if I were to ask you, for example,to make a one-time investment of, say,200 million dollarsto buy one of those bottles,so 200 million dollars up front, one time,to buy one of those bottles,I won't tell you which one it is,and in 10 years, I'll tell you whether
you have one of the blue ones.Does that sound like a good deal for anybody?No. No, right?And of course, it's a very, very risky trial position,and that's why it's very hard to get funding,but to a first approximation,that's actually the proposal.You have to fund these thingsfrom the early stages on. It takes a long time.

4:48
So Andrew said to me, he said,"What if we stop thinking about these as drugs?What if we start thinking about
them as financial assets?"They've got really weird payoff
structures and all that,but let's throw everything we knowabout financial engineering at them.Let's see if we can use all the tricks of the tradeto figure out how to make these drugswork as financial assets?

5:09
Let's create a giant fund.In finance, we know what to dowith assets that are risky.You put them in a portfolioand you try to smooth out the returns.So we did some math, and it turned outyou could make this work,
but in order to make it work,you need about 80 to 150 drugs.

5:23
Now the good news is, there's plenty of drugsthat are waiting to be tested.We've been told that there's a backlogof about 20 years of drugsthat are waiting to be tested but can't be funded.In fact, that early stage of the funding process,that Phase I and pre-clinical stuff,that's actually, in the industry,
called the Valley of Deathbecause it's where drugs go to die.It's very hard to for them to get through there,and of course, if you can't get through there,
you can't get to the later stages.

5:47
So we did this math, and we figured out, okay,well, you know, you need about 80 to, say, 150,or something like that, drugs.And then we did a little more math, and we said,okay, well that's a fund of aboutthree to 15 billion dollars.So we kind of created a new problemby solving the old one.We were able to get rid of the risk,
but now we need a lot of capital,and there's only one place to get that kind of capital,the capital markets.Venture capitalists don't have it.
Philanthropies don't have it.But we have to figure out how we can
get people in the capital markets,who traditionally don't invest in this stuff,to want to invest in this stuff.So again, financial engineering was helpful here.Imagine the megafund actually starts empty,and what it does is it issues some debtand some equity,and that generates cash flow.That cash flow is used, then, to buythat big portfolio of drugs that you need,and those drugs start working their waythrough that approval process,and each time they go through
a next phase of approval,they gain value.And most of them don't make it,but a few of them do,and with the ones that gain value, you can sell some,and when you sell them,you have money to pay the interest on those bonds,but you also have money to
fund the next round of trials.It's almost self-funding.You do that for the course of the transaction,and when you're done, you liquidate the portfolio,pay back the bonds, and you cangive the equity holders a nice return.

6:59
So that was the theory, and we talked about itfor a bit, we did a bunch of experiments,and then we said, let's really try to test it.We spent the next two years doing research.We talked to hundreds of experts in drug financingand venture capital.We talked to people who have developed drugs.We talked to pharmaceutical companies.We actually looked at the data for drugs,over 2,000 drugs that had been approved or deniedor withdrawn,and we also ran millions of simulations.And all that actually took a lot of time.But when we were done, what we found was something that was sort of surprising.It was actually feasible to structure that fundsuch that when you were done structuring it,you could actually produce low-risk bondsthat would be attractive to bond holders,that would give you yields of
about five to eight percent,and you could produce equitythat would give equity holders
about a 12-percent return.Now those returns aren't going to be attractiveto a venture capitalist.Venture capitalists are those guys
who want to make those big betsand get those billion dollar payoffs.But it turns out, there are lots of other folks
that would be interested in that.That's right in the investment sweet spotof pension funds and 401(k) plansand all this other stuff.

8:05
So we published some articles
in the academic press.We published articles in medical journals.We published articles in finance journals.But it wasn't until we actuallygot the popular press interested in thisthat we began to get some traction.

8:18
We wanted to do something more than
just make people aware of it, though.We wanted people to get involved.So what we did was, we actually
took all of our computer codeand made that available onlineunder an open-source licenseto anybody that wanted it.And you guys can download it todayif you want to run your own experiments
to see if this would work.And that was really effective, because peoplethat didn't believe our assumptionscould try their own assumptions
and see how it would work.

8:39
Now there's an obvious problem, which is,is there enough money in
the world to fund this stuff?I've told you there's enough drugs,but is there enough money?There's 100 trillion dollars of capitalcurrently invested in fixed-income securities.That's a hundred thousand billion.There's plenty of money.(Laughter)

9:02
But what we realized was that it's
more than just money that's required.We had to get people motivated,
people to get involved,and people had to understand this.And so we started thinking about all
the different things that could go wrong.What are all the challenges to doing
this that might get in the way?And we had a long list, and so what we did waswe assigned a bunch of people, including ourselves,different pieces of this problem,and we said, could you start
a work stream on credit risk?Could you start a work stream
on the regulatory aspects?Could you start a work stream onhow you would actually manage so many projects?And we had all these experts get togetherand do these different work streams,and then we held a conference.The conference was held over
the summer, this past summer.It was an invitation-only conference.It was sponsored by the American Cancer Societyand done in collaborationwith the National Cancer Institute.And we had experts from every field
that we thought would be important,including the government, includingpeople that run research centers and so on,and for two days they sat around
and heard the reportsfrom those five work streams,
and they talked about it.It was the first timethat the people who could actually make this happensat across the table from each otherand had these conversations.

10:04
Now these conferences, it's typical to have a dinner,and at that dinner,you kind of get to know each other,sort of like what we're doing here.I happened to look out the window,and hand on my heart, I looked out the windowon the night of this conference --
it was the summertime --and that's what I saw, it was a double rainbow.So I'd like to think it was a good sign.

10:23
Since the conference, we've got people workingbetween Paris and San Francisco,lots of different folks working on thisto try to see if we can really make it happen.We're not looking to start a fund,but we want somebody else to do this.Because, again, I'm not a scientist.I can't build a drug.I'm never going to have enough moneyto fund even one of those trials.But all of us together, with our 401(k)'s,with our 529 plans, with our pension plans,all of us together can actually fund hundreds of trialsand get paid well for doing itand save millions of lives like my dad.